HomeMy WebLinkAbout0550 STRAWBERRY HILL ROAD - Health 550 STRAWBERRY HILL RD.
HYANNIS
A = 249 166 F
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TOWN OF BARNSTABLE
LOCATIor�--); �.Sb S 71Z i h ryl n�iRi7 SEWAGE # 406 1 .
VLLAGE e"g ki e r Vi Ile- ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ZT-OorbS lei*e-hIrk
SEPTIC TANK CAPACITY loco 6-44-
LEACHING FACILITY: 10 SO 5 �� {(type) � (size)
- �tP.
NO.OF BEDROOMS
BUILDER OR OWNER Piz�-eK .S a m
PERMITDATE: ZC a COMPLIANCE DATE: 7 - l Z d
' Separation Distance Between the:
,Iviaximurn Adjusted Groundwater Table and Bottom of Leaching Facility Feet
,,,,,Private Water.;Supply Well and Leaching Facility (If any wells exist
rF on"site or,within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
z Wp a
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r ,�
' . TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE ASSESS 'S MAP & LOT /7/
!?43P C:,f S"NAME&PHONE NO.
SEPTIC TANK CAPACITY ) /� �)
LEACHING FACILITY: (type) �b.�� (size)
NO.OF BEDROOMS .2
BUILDER t!O!W!rNTERi
PERMIT DATE: COMPLIANCE DATE:
5
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by y/f
- � .
O �
1
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,. +k
I' ' /L g ...,,. .. ! _ 't' Fee
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Biopool bpotem Con!gtrurtion permit
Application for a Permit to Construct( .6Tkepair( )Upgrade( )Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. �Q S Q b Z (� a i Owner's Name,Address and Tel.No.
N,N go
Assessor's Map/Parcel `y t, 40
�r��R SBh
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
- ,1 wW04 w.qjnj5R 111-2y25(
9 o 6�-,K ,&V+&V
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3o gallons per day. Calculated daily flow T.r gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank E)r+s+t a Ivoo 6-41— 1 Type of S.A.S. l o tw s 1 N F,C PK f 4AS
Description of Soil; Inn z Y) S[9�►d
Nature of Repairs or Alterations(Answer when applicable) /H 9 oA-
2C � /22 ' era
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued this d f Health.
Signed B Date 0-6 — �1
Application Approved by Date 6 a--o l
Application Disapproved for the following re ons
Permit No. Date Issued
.a. y� � � .3�• .wc .., "`-fo 't.. ^t�-,- - ., -max
TOWN OF B'ARNSA$T. z CE
=LOCATIONSb- ?l; 1y I9 rR 1? l�i/I `+ A�7 SEWAGE'# �(I�'1 I
/
VILLAGE. r gv►-�-c"K V�/ ASSESSORS MAP & LOT�t/� I
INSTALLER'S NAME&PHONE NO. V.
SEPTIC TANK CAPACITX 64L..
LEACHING FACILITY: �" A'o SD s j
(type) (size) 2 y YI
NO.OF BEDROOMS -
BUILDER OR OWNERai
PERMIT DATE: Z C -o t
COMPLIANCE.'DATE: 7 /Z =.� (" Z.
Separation Distance Between ttie
t•.::x:.
Maximum Adjusted Groundwater Table,and Bottom of:Leaching Pacility Feet
Private Water Supply.Well an
Well Facility (If any wells exist
on site'or within 200 feet:of"leaching faczl;ty) Peet 4 u
Edge of Wetland and Leaching PactLty:('If any wetlands e�ust
i
witlun;300 feet of leaching facility
Fiimished by 1
F.
i
F�
"
v
3 Sz
- 27
No. / /Z/ c► �.+� Fee
t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer-: ✓
:. Yes
" —PUBLIC HEALTH DIVISION -TOWN OFr BARNSTABLE,, MASSACHUSETTS
ZippYication for Mioogar *pgtem Construction Permit
Application for a Permit to Construct( &�rRepair( )Upgrade( )Abandon( ) ❑Complete System OKdividual Components
Location Address or Lot No. /�['O S fi ��W b t��!� Owner's Name,Address and Tel.No.
I-l�// go 7
Assessor's Map/Parcel Z
10_AnNM
Installer's Name,Address,and Tel.No. I $' Designer's Name,Address and Tel.No.
7w►�s 1s�R `7yl- ay2q
D 6�'Ka�G NHS'�fi0 �/• �• .
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3b gallons per day. Calculated daily flow 3 gallons.
Plan Date Number of sheets Revision Date
Title `A
Size of Septic Tank )rIS+IaAL /a ev UNt_ Type of S.A.S. 3 8 o tv s i ti K�C fits R feR1
Description of Soil Lvi r p S A n n
Nature of Repairs or Alterations(Answer when applicable) I h M.rw Cl g oY
`Zn SOS im P L }Ana of,5 a nF • 60dhe-
Date last inspected: S x 'S- -7 X X -c Sy_.�
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore,des-cribed on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued Ppthis B d f Health. ,.*\a
Signed- Date (76 —2 3 of
Application Approved by Date 6—m--o l
Application Disapproved for the following rea ons
i
Permit No. Date Issued
,
--------_— --------------------------------— - -
THE COMMONWEALTH OF MASSACHUSETTS VQ,'-_4- 4- 0 bip'4
BARNSTABLE, MASSACHUSETTS 6t,, ,4-`"4.&4 7•
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Graded( )
Abandoned( )b�t Zr VW s !ti L K F
at lkf CL v OZI has been constructed in accordance
with the provisions of Title 5 and di for Disposal System Construction Permit No. ZQV 1'tl Z dated 6 " 7& 0
Installer 'Sh W Ars U44-kjrX Designer
The issuance of this permi shall 5ot be construed as a guarantee that the ill functio a esigne (I
Date � Z Z Inspectorsys
i
9 / �
No. ---— —
��/ ��tO�I ----------- --Fee -i "/
i�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
;Di5po5al *pgtem Cow5truction Permit
Permission is hereby granted to�Construct( )Repair rade( )Abandon( )
System located at e s'} R R k.'b 4-RR Flip/ nd
«4
c
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must a completed within three years of the date of this pe
Date: Z� � Approved by
i
116i99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. _
CERT117CATION OF SKETCH AND .kPPLICATION FORA DISPOSAL
WORKS CONSTRUCTION PEP MIT (RTI-ROUT DESIGYEI}PL,�NSI
WES herebv cermry that the application fbt disposal wor's
consucnon pe..L -[..signed by me dated (7(o_ Z S 0/ concerning the
grope ry located at 950 S 7f, b Hill AD meets all of the
following c-ite:ia: Ir
• i fie failed sysem is connected to a residential dwelling only. T r=-- are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the pe:coladon rate is less than or equal to 5 minutes pet inch.
1 inete are no we•!ands within 100 fe`:of the orotosed septic se e*�
• Tne_e arc no orivaic wets within 1-50 fee:of the proposed sciuc s-+serrt
• There is no incegse in flow and/or cHange in use proposed
• Tnere are no vananc=s requessed or needed
• T nc bottom of the propascd leacsi.ng facility-will not be located less than five feet above the
tna.=urn adjured groundwater table e!cvation (�djus the�oulndzvate:table using the rrimptor
me;hcd when applicable]
• if the S.A.-S. will be-tocated wit,�t_50 fe_:of an-i vegetated we,lands. the bottom of the proposed
lea hin;faclit will net be fccz ted!ess than foulrte_n(1�) fe_;above the tna cimulrrt adiused
Q*ou ndwater table e!evadort,
Plesse complete the followin;:
A) Too of Ground SILT acz =irration(using GIS inforztauon)
B) G.W. E?evatian 99 t , • '
J -the�L < ,i_h G. N. Adjusment
D Cr—: E?1�iCt 3 E-1-WE N A and 3 go
196
Da.i�:
(S.:etch plose plan of s:sent on bac':�.
.r Guth;olds:o_.,
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UAW%Re
,- Town of Barnstable
Department of Health,Safety and Environmental Services
Public Health Division,367 Main Street Z 273 502 590
P.O.Box 534
Hyannis,MA 02601 6
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O pos/ neaF No 0 e. al. 1st NOTICE fE8_��2Q8Q
r a9eU4 o/* raer 2rd NOTICE e rq 3
RILED � -�
RETURNED � .
m SENDER: 1 also wish to receive the a f
■Complete items 1 and/or 2 for additional services.
m ■Complete items 3,4a,and 4b. following services(for an I
d ■Print your name and address on the reverse of this form so that we can return this extra fee):
^ card to you.
■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
permit. '..
d. ■Write'Retum Receipt Requested'on the ma piece below the article number. 2. ❑ Restricted Delivery (A '
$ ■The Return Receipt will show to whom the Aide was delivered and the date a
C delivered. Consult postmaster for fee. g
o
3.Article Addressed to: 4a.Article Number a I
o yralx E
E 4b.Service Type
❑ Registered IS Certified of
(A U a ❑ Express Mail ❑ Insured
'CUC ❑ Return Receipt for Merchandise ❑ COD
7.Date of Delivery
' I
I 5.Received Bfw!Nao 8.Addressee's Address(Only if requested a
and fee is paid) t
c..•_ =7� v (lu o_i r,s c n I 6.Signature(Assee.o Agent)
t t i t r` r ' " a r i 102596:97-Ml-79 Domestic Return Receipt
o L-— ---- - ,r
Town of Barnstable
&4PN ABM
Department of Health, Safety, and Environmental Services
KAS& Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
550 STRAWBERRY HILL RD.
CENTERVILLE MA. 02632
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
The septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
on 08/01/97, by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of 1995
TITLE 5 (310 CMR 15.00) due to the following:
BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL
The--above°system, according to our records has been in a.failed state for more than two years.
Therefore,,you,are,directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposi drsystem that,will;bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code,;Title.5 within(14)fourteen days of receipt of this notice.
the septic system: st be brought into compliance within(30) thirty days of your receipt of this
directive.
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any court
of competent jurisdiction as provided for by the laws of the Commonwealth:
PE OF THE BOARD OF HEALTH '
mas A. McKean, R.S., C.H.O. ,
Agent'of the Board of Health
Trown of Barnstable
q M1ealthWbfil®Wtle32yndoe'j. r
De artment of Health,Safe and Environmental Services ,, �� � f +���.i,`t j i i 6 �� t r(r t t:: , t t i t
Town ofBarnstahle'~ r , y
P ty' RETURN RECEIPT REQUESTED PNN�''�iy.;�`'rZY
Z 2 0 3 499 8 8 s �� U.S.POSTAGE
P.O.Box 534 JAN24'00 a «
Hyannis,MA 02601 J � z' .9 8 `
PBMEIER
6138443 t
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SFNOFR �� ..
a'VolO9T iE l
Uaabletiver„bleAsgddre$, MARGARET B. P RSON
Q to J Tp Forward � n
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�ficientAddress 550-STRAWB * HILL RD. RETUI
uncted lefl No,gadr -- CENTER,... E;MA OW,
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aimed ess « , .
a Attem t Refused 1st NOTlC FEB pe E 1 M
1
a No such d No Known 2nd NOTIC
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a Vacant a et a Numbe .
a No Illegible r V RETURNED
Mail Rec a
080 x C'l ePtacl is -
a Return osed No Order -
�. ed For
O postage Auer Betrer gddress w.r:
711
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UNITED STATES POSTAL SERVICE111111 First-Class MailPostage&Fees Paid
USPS
Permit No.G-10
C Print your name, address, and ZIP Code in this box G
Board of Health
Town of Barnstable
P.O. Box 534
Hyannis,Massachusetts 02601
i
d SENDER:
O ■Complete items 1 and/or 2 for additional services. I also wish to receive the
(A ■Complete items 3,4a,and 4b. following services(for an
4) ■Print your name and address on the reverse of this form so that.we can retum this extra fee):
card to you.
■pAtttrach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
d Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N
r ■The Return Receipt will show to whom the article was delivered and the date z „
C delivered. Consult postmaster for fee:' a
v 3.Article Addressed to: 4a.Article Number
Z 203 y99 I '�' E
4b.Service Type
c
(.1� A ❑ Registered Certified
c1/ Im
❑ Express Mail ❑ Insured S
LU
G ��/(// ��Q/ ❑ Return Receipt for Merchandise ❑ COD
LU
a 7.Date of Delivery
0
5.Received By:(Print Name) 8.Addressee's Address(Only if requested
~ - and
W fee is paid)
C. t
m �'•Ul)�
g B-Signature: e,orA.� nt)
, X z` ��
PS'Form 3811 Deceli l6er 1644 102595-97-13-0179 Domestic Return Receipt
.� ,. Town of Barnstable
Department of Health, Safety, and Environmental Services
119- 04 Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
1595 MAIN ST.
WEST BARNSTABLE, MA. 02668
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
_ The'septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
on 08/01/97 by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00) due to the following:
'(BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL."
The above system, according to our records has been in a failed state for more than two years.
Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice.
The septic system must be brought into compliance within (30) thirty days of your receipt of this
directive.
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any court
of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORD OF BOARD OF HEALTH
T mas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
,:�w&n1dWt1e52,.dw
.r, Z 273 502 590
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See reverse
n
tr t&IRumber
Post , ,S te, ZIP Code
Postage $
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing to
Whom&Date Delivered
Q Return Receipt Showing to Whom,
Q Date;&Addressee's Address
0 TOTAL Postage&Fees $
co
M Postmark or Date
0 t
(0
a-
Stick postage stamps to article to cover First-Class postage,certified mail fee,and
I charges for any selected optional services(See front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service
i window or hand it to your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the
return address of the article,date,detach,and retain the receipt,and mail the article.
LO
3. If you want a return receipt,write the certified mail number and your name and address rn
on a return receipt card,Form 3811',and attach it to the front of the article by means of the
gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article 0—
RETURN RECEIPT REQUESTED adjacent to the number. Q
4. If you want delivery restricted to the addressee, or to an authorized agent of the O
O
addressee,endorse RESTRICTED DELIVERY on the front of the article. M
5. Enter fees for the services requested in the appropriate spaces on the front of this E
receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. io
6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 W
is
.� .� Town of Barnstable
Department of Health, Safety, and Environmental Services
MPUMABLE
3 9. Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
550 STRAWBERRY HILL RD.
CENTERVILLE MA. 02632
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
The septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
on 08/01/97, by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of 1995
TITLE 5 (310 CMR 15.00) due to the following:
BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL
The above system, according to our records has been in a failed state for more than two years.
Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice.
The septic system must'be brought into compliance within (30) thirty days of your receipt of this
directive.°
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any court
of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health `
Town of Barnstable
gJtWth\&ti1W1itle32y.&c , .
� ,. Town of Barnstable
BARMABL& Department of Health, Safety, and Environmental Services
MA
SS. Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
550 STRAWBERRY HILL RD.
CENTERVILLE MA. 02632
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
The septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
on 08/01/97, by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of 1995
TITLE 5 (310 CMR 15.00) due to the following: .
BACKUP OF 'SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO. AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL
The above system, according to our records has been in a failed state for more than two years.
Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice.
The,septic system must be brought into compliance within (30) thirty days of your receipt of this
directive.
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any court
of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O:
Agent of the Board of Health
Town of Barnstable
r
q:hWthAfl1eettWe52y.&c -
t
Z 203 499 188
US Postal Service ^�
Receipt for Certified Mail
No Insurance Coverage Provided. -
Do not use for International Mail See reverse
Sent to
Street& r�r bLerr/L t'/TUL
�s- S Ya4,kl
Pgsj O ce,State,& IP Code y
Postage $ T� ✓�/7
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing to
Whom&Date Delivered
Q Return Receipt Showing to Whom,
Q Date,&Addressee's Address
0 TOTAL Postage&Fees is
c+3 Postmark or Date
0
a 12
Stick postage stamps to article to cover First-Class postage,certified mail fee,an�
charges for any selected optional services(See front). y
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service a
window or hand it to your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m
j return address of the article,date,detach,and retain the receipt,and mail the article. LO
f �
4 3. If you want a return receipt,write the and
mail number and your name and address
on a return receipt card,Form 3811,and attach it to the front of the article by means of the
gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a
( RETURN RECEIPT REQUESTED adjacent to the number. Q
i C
M 4. If you want delivery restricted to the addressee, or to an authorized agent of the �
addressee,endorse RESTRICTED DELIVERY on the front of the article. M
5. Enter fees for the services requested in the appropriate spaces on the front of this 1_
receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti
6. Save this receipt and present it if you make an inquiry. 102595-97-6-0145 d
.�` Town of Barnstable
• Department of Health, Safety, and Environmental Services
MAM
i679. A��
Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
1595 MAIN ST.
WEST BARNSTABLE, MA. 02668
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
The septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
on 08/01/97 by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00) due to the following:
'rBACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL.
The above system, according to our records has been in a failed state for more than two years.
Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice.
The septic system must be brought into compliance within (30) thirty days of your receipt of this
directive.
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
An person aggrieved b an order issued b the local approval authority may appeal to an court
Y P gg Y Y Y PP tY Y PP Y
of competent jurisdiction as provided for by the laws of the Commonwealth.
PER ORD OF BOARD OF HEALTH
T mas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Town of Barnstable
q:ndw�meu;uoy.a«
Town of Barnstable
+ -Department of Health, Safety, and Environmental Services, ,
MASS.
��� Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790.6304 Director of Public Health
TO: MARGARET B. PETERSON DATE: JAN. 20, 2000
550 STRAWBERRY HILL RD.
CENTERVILLE MA. 02632
ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,
TITLE 5.
The septic system owned by you located at 550 STRAWBERRY HILL ROAD was inspected
On 08/01/97, by ROBERT BORTOLOTTI a Massachusetts licensed septic inspector.
The inspection of your septic system showed that your system has failed under the guidelines of 1995
TITLE 5 (310 CMR 15.00) due to the following:
1
BACKUP OF SEWAGE INTO FACILITY OR` SYSTEM COMPONENT DUE TO AN
OVERLOADED OR CLOGGED SAS OR CESSPOOL
The above system, according to our records has been in a failed state for more than two years.
Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch
a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The
State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice.
The septic system must be brought into'compliance within (30) thirty days of your receipt of this
directive.
You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic
system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or
into surface waters.
Any person aggrieved by any order issued by the local approval authority may appeal to any court
of competent jurisdiction as provided for by the laws of the Commonwealth.
1
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health {
Town of Barnstable
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N 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648
508-771-9399 508-428-8926 FAX: 508-428-9399 Z ti
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 0;z
Date of Inspection: -7 7 In pector's ne:
er's Nam d Address:
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal systems. The System:
Passes
Conditionally Passes
Needs-Further Eval WnBLocal Aproving Authority .
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional
office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
A)SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any.failure criteria not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system, upon comple-
tion of the replacement or repair, passes inspection.
Indicate yes, nor,or not determined(Y,Ni OR ND). Describe basis of determination in all instances. If
not determined",explain why not.
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
- 1 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM
PART A
CERTIFICATION (continued)
r�
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
Broken pipe(s)are replaced
Obstruction is removed
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by The Board of Health in order to determine if
the system is failing to protect the public health,safety and the environment. 4
1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH.AND,SAFETY,AND THE
ENVIRONMENT: .
The system has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or'tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well,unless a well water analysis for coliform x :
ar,
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal to or less
than 5 ppm.
D) STEM FAILS:
on
e or more of the following failure criteria as defined
y� system violates g Y 'n at the s determined that I have dete sy
in 310 MR 15.303. The basis for this determination is identified below. The Board of Health
sho d be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the surface of the ground or surface waters due to an
overloaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than b"below invert or available;volume is less than 1/2
day,flow.
Required pumping-more than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspooi'or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 Feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or more of the following
conditions exist:
The system is within 400 Feet of a surface drinking water supply
The system is hithin200 Feet of a tributary to a,surface drinking water supply.
The system is located in a nitrogen sensitive area Interim Wellhead Protection Area
(IWPA)or a mapped Zone II of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
yPumping information was requested of the owner,occupant,and Board of Health.
✓None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
VAs-built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for.signs of sewage back-up.
/The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
All system components,excluding the Soil Absorption System, have been located on site.
he septic tank manholes were uncovered,opened, and.the interior of the septic tank was in
s` eted for condition of baffles or tees, material of construction,dimensions,depth of liquid,
epth of sludge,depth of scum.
he size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
-3-
r F 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
n from owner were provided with information on
f/ ants if different facility caner and'occupants, ) P
The facrl o ,ty ( P
the proper maintenance of Subsurface Disposal System
SUB
SURFACE SEWAGE DISP
OSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION`
/ FLOW CONDITIONS
Design Flow: allons Number of Bedrooms:-,,?,— Nurnbcr of Current Residents:_
Garbage Grinder: Laundry Connected To Systcm: !tea Seasonal Use:
Water Meter Readings,if rlable:
Last Date of Occupancy:
CO MERCLAiaiNDUSTRUL. 0 ,
Type of Establishment: '
Design Flow: gallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
. Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: _ Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENE IN
PUMPING RECORDS and source of information:U
- p /
System Pumped as part of inspection:,U(} if yes,volume pumped:' gallons
Reason for pumping:
TYPE OF SYSTEM:
Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System s,attach previous inspection re 1 ds, if any)
(explain)•
AfFROXIMATE AGE of all components,dale installed(if known)and source of information:
Sewage odors detecte when arrMngat t site: .1_)O
-4-
a r ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: �� Material of Construction: concrete metal FRP_Other
(explain)
Dimisions: .5' (p' S V Sludge Depth: Scum Thickness: /
r
Distance from top of sludge to bottom of outlet tee or baffle: 3 V
Distance from bottom of scum to bottom of outlet tee or baffle: /2
Comments: (recommendation`for'puriipirig,condition of inlet and outiet tees or baffles,depth of liquid
I el in lation outlet invert,structural integrity,evidence of leakag ,etc:)&Q
�r
GREASE TRAP:_
Depth Below Grade: Material of Constructioii:_concrete_metal -FRP Other
(explain)
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments:.(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level.in relation to outlet invert, structural integrity,evidence.of leakage,etc.)
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_concrete_metal_FRP Other(explain)
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
Depth of liquid level above outlet invert:
Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into
or out of box,etc.)
_.. PUMP CHAMBEI
Pump is in working order:
Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.)
-5-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS): 1/
(Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits, number:Leaching chambers,number: Leaching galleries,number:
Leaching trenches, number, length:
Leaching fields, number,dimensions:
Overflow cesspool, number:
Co nts: (note condition of soil signs of hydra lic failu level of nding,condition of vegetati ,
etc. OOU i
// -
CESSPOOLS::
Number and configuration: Depth-top of liquid to.inlet invert:
Depth of solids layer: Depth of scum layer: Dimensions of Cesspool:
Materials of construction`. Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
-G -
FORM
'F DISPOSAL SYSTEM INSPECTION O
SUBSURFACE SEWAGE(,
PART C
SYSTEM INFORMATION (conlimmed)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or hemchmiarks.
Locate all wells within 100 Feet.
co
r
DEPTH TO GROUNDWATER: ,
Depth to groundwater: Feet ,
Method of Determination or Appro 'mation:
-7-
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